title: Early detection and prediction of cardiotoxicity in chemotherapy-treated patients.
abstract: As breast cancer survival increases, cardiotoxicity associated with chemotherapeutic regimens such as anthracyclines and trastuzumab becomes a more significant issue. Assessment of the left ventricular (LV) ejection fraction fails to detect subtle alterations in LV function. The objective of this study was to evaluate whether more sensitive echocardiographic measurements and biomarkers could predict future cardiac dysfunction in chemotherapy-treated patients. Forty-three patients diagnosed with breast cancer who received anthracyclines and trastuzumab therapy underwent echocardiography and blood sampling at 3 time points (baseline and 3 and 6 months during the course of chemotherapy). The LV ejection fraction; peak systolic myocardial longitudinal, radial, and circumferential strain; echocardiographic markers of diastolic function; N-terminal pro-B-type natriuretic peptide; and high-sensitivity cardiac troponin I were measured. Nine patients (21%) developed cardiotoxicity (1 at 3 months and 8 at 6 months) as defined by the Cardiac Review and Evaluation Committee reviewing trastuzumab. A decrease in longitudinal strain from baseline to 3 months and detectable high-sensitivity cardiac troponin I at 3 months were independent predictors of the development of cardiotoxicity at 6 months. The LV ejection fraction, parameters of diastolic function, and N-terminal pro-B-type natriuretic peptide did not predict cardiotoxicity. In conclusion, cardiac troponin plasma concentrations and longitudinal strain predict the development of cardiotoxicity in patients treated with anthracyclines and trastuzumab. The 2 parameters may be useful to detect chemotherapy-treated patients who may benefit from alternative therapies, potentially decreasing the incidence of cardiotoxicity and its associated morbidity and mortality.
authors.affiliation: Cardiac Ultrasound Laboratory and Division of Cardiology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Heloisa
authors.initials: H
authors.lastname: Sawaya
authors.forename: Igal A
authors.initials: IA
authors.lastname: Sebag
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Plana
authors.forename: James L
authors.initials: JL
authors.lastname: Januzzi
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ky
authors.forename: Victor
authors.initials: V
authors.lastname: Cohen
authors.forename: Sucheta
authors.initials: S
authors.lastname: Gosavi
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Carver
authors.forename: Susan E
authors.initials: SE
authors.lastname: Wiegers
authors.forename: Randolph P
authors.initials: RP
authors.lastname: Martin
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gerszten
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.forename: Jonathan
authors.initials: J
authors.lastname: Passeri
authors.forename: Irene
authors.initials: I
authors.lastname: Kuter
authors.forename: Marielle
authors.initials: M
authors.lastname: Scherrer-Crosbie
mesh_terms: D000328:Adult; D018943:Anthracyclines / Q000633:toxicity*; D000911:Antibodies, Monoclonal / Q000633:toxicity*; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents / Q000633:toxicity*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000633:toxicity*; D001943:Breast Neoplasms / Q000188:drug therapy; D004452:Echocardiography; D005260:Female; D006801:Humans; D020097:Natriuretic Peptide, Brain / Q000097:blood; D013318:Stroke Volume; D000068878:Trastuzumab; D016896:Treatment Outcome; D019209:Troponin C / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000139:chemically induced*
chemical_list: D018943:Anthracyclines; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D019209:Troponin C; D020097:Natriuretic Peptide, Brain; D000068878:Trastuzumab